William Shippen, Jr.

Special Article WILLIAM SHIPPBN, JR. THE GREAT PIOKJi~ER IN AMERICX~\ 0BSTE1'RICS HERBER'l' THOMS,

1\LD.,

NEW HAVEK, COKN.

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ILLIAM SHIPPEN, JR., of Philadelphia is the great pioneer in American Obstetrics for he wa..;; the first lecturer on that subject in tl1is country and the first to establish a hospital for such instruction. His early course of anatomical lectures, 1762 and 1763, represents in fact the beginnings of medical teaching in Ameri(•a. Shippen belongs to that eomparativ(·ly small group of men in medicine who are famous sons of famous fatherK His father of the same name was descended from Edward Shippen, a member of the Society of Friends who emigrated to Boston from Cheshire, England, in 1668. At the request of William Penn this anct's1or soon removed to Philadelphia and as first mayor of that city is said to have become distinguished as having three great things: ''the biggest house, the biggest person, and the biggest coach.'' Edward's son Joseph married Abigail Grosse and William Shippen (Sr.) was born to them Oct. 1, 1712. He was wholly educated in his native city and became a leader in medicine in his time. He was the first physician to the Pennsylvania Hospital, a founder of the University of Pennsylvania, and a founder of the College of New Jersey (Princeton University). In 1778 he was elected to the Continental Congress and he was one time vice-president of the American Philosophical Society. William Shippen, ,Jr., was one of four sons horn to Susannah Harrison and William Shippen, and was born in Philadelphia Oct. 21, 1736. As a boy he attended the Rev. Samuel I'1 inley 's academy in Nottingham, Pa. This school was one of the important edncational influences in colonial America and its proprietor subsequently became President of the College of New Jersey. Among fellow students of ·william Shippen at the academy were John Morgan and Benjamin Rush. From Nottingham the young Shippen entered the College of New Jersey, then under the presidency of Aaron Burr, father of the Vice-President of that name. In 1754 he reeei ved his bachelor's degTee and at commencement was chosen to deliver the valedictor.v addres..-;. The great preacher, George Whitefield, an auditor on that occasion, is said to have been so impressed that he urged the young orator to enter the pulpit. Shippen's mind, however, was set on the profession of his father and he returned to Philadelphia where he studied until1758 at which time he went abroad to complete his education. According to Watson, quoted by Packard, a letter written by his father at this time to an English correspondent reads, ''My son has had his education in the best college in this part of the country, and has been studying physic with me, besides which he has had the opportunity of seeing the practice of every gentleman of note in 512

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our city. But for want of that variety of operations and those frequent dissections which are common in older countries, I must send him to Europe. His scheme is to gain all the knowledge he can in anatomy, physic, and surgery.'' The young student's ''scheme'' could hardly have failed in the environment in which he found himself shortly after arriving in England. His first residence in London was in the family of John Hunter who at that time was assisting his brother William in the latter's anatomical theater. By means of this association he became friendly with William Hewson and Sir John Pringle, and also at this time came under the notice of Dr. John Fothergill. Fothergill, born of a '~uaker family and a leading J. . ondon physician, had a great interest in the Pennsylvania Colony and in the newly established Pennsylvania

William Shippen, Jr. (From a portra it in the College of Physicians, Philadelphia.)

Hospital. He was also greatly interested in the young man who was planning to carry the latest teachings of the old world to the new. At the expense of 200 guineas Fothergill employed the artist Rensdyck to execute drawings of anatomical structures. The dissection for this purpose is said to have been made by an anatomist named Jenty and John Hunter is reported to have had a hand in the enterprise. These pastel drawings, eighteen in number, and three plaster of Paris castings of the abdomen of a pregnant woman were presented to the Pennsylvania Hospital and today are among the choice possessions of that institution. William Shippen had a particular interest in midwifery and attended for a time lectures given by Colin Mackenzie, a one-time pupil of Smellie. Shippen received his medical degree from Edinburgh, the title of his thesis being "De Placentae Cllm Utero Nexu. " While in the northern

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capital his opportunities were enriched under the instruction of Munro Primus and Cullen. From the foregoing and what I shall mention in following it seems probable that no yonng man of colonial Ameri<-a ·who went abroad to study medieinc ever had a richer experience or <'ame in1 o finer conta<'t with the great masters of that day. William Shippen wa:-: apparentl~r one of those fortunates who are "horn aright in time n1trl place.'' After finishing his studies at Edinburgh his desire was to contiml<' studying in France. That country was then at war and this trip was made possible only after his friend Sir ;John Pringle had secured for him a position as travelling physieian to a lady journeying to southem Franee for her health. He resided for a short time in France and 'vhile t IH•re apparentl.v met among othN notables that genius of literary nhstPtries, Lanrenee 1-::lterne, for in a letter written to David Garri<·k from Paris in Marc-h, 1762, Sterne writes, "This will be 1mt into yom· hands h;~ Dr. Shippen who has been here some time \Vith l\Iiss Poyntz and is ihis moment setting off for ;·om· metropolis." 'While in London Shippen had beeome engaged to Alke Lee, daughter of the Honorable Col. Thomas Lee, ac-ting governor of the Colony of Viq~inia. She wa:;; the sister of Hichard Henry Lee and .F'rancis Lightfool L('l'. hoth of whom W<'re ''Signers.'' Following the death of hm· parents she had gone to live with lwr uncle, Philip Ludwell III, in London. Among the l'ircle ol: ftiends whom ·william Shippen found in this household may be mentioned, I<'anny Burney. Dr. Samuel ,Johnson. BoswelL John Paradise, and his own benefactor ,John Hunter. His mat·riagt' took plaee April3, 1762, at the Church of St. Mary IJe Strand, Middlesex. Within a few days the bride and groom sailed for America where a new house was awaiting' them. a present from ·william Shippen, Sr. This house, whirh is still Rtanding at the comer of TJocust and Sprure Streets, was to hecomt• an important landmark in the hi~tory of our c-ountry and expresses, says a writer. "the quiet dignity and well being· of the lift' of the early American aristoeraey. '' The Fothergill drawings rame to AmeriC'a soon after Shippen's arrival in May. 1762, and tlw llonor in a letter to .Tames Pemberton mentioning· Shippen says, "that he i:-< well qualified---that lw will soon be foJlowed by an able assistant, Doetor ,John Morgan, and, that if countenanced by the legislature they will he verv useful. and ereet a sehool of medicine." At the time of Shippen's ;trrival in Philadelphia in practice there besides his father were the brothPrs Thomas and Phineas Bond, Thomas Cadwalader, John Redman, and Cadwalader Evans. Shippen's plans for leet11ring \H'J'(' not dl'lu;n:d for in a newspaper h•tter of Nov. 11. 1762, he stated "that a eom·r-;e of anatomieallertures will he opened this winter in Philadelphia fm· the advantage of tlw young gentlemen now engaged in the study of physic in this and the neighboring provincer-;, whose• <'irenmstances and connections will not permit of their going abroad for improvement to the anatomical schools in Europe; and also for the entertainment of any gentlemen who may have the curiosity to understand the anatomy of the human frame. In these lectures the situation, figure, and structure of all the parts of the human body will be demonstrated, their respeetive uses explained, and as far as a course of anatomy will permit, their diseases, with the indications and methods of cure briefly treated of. All the necessary operations in surgery will be performed, a course in bandaging exhibited, and the whole concluded with the explanation of some of the curious

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phenomena that arise from an examination of the gravid uterus, and a few plain general directions in the study and practice of midwifery. The necessity and public utility of such a course in this growing country, and the method to be pursued therein, will be more particularly explained in an introductory lecture, to be delivered on the sixteenth instant, at six o'clock in the evening, at the State House, by William Shippen, M.D." 'I'he first course of lectnres was attended by twelve pupils. The opposition of the public to dissection was demonstrated on several occasions by the smashing of windows in the house where they were performed. The young lecturer sought to soothe this antagonism by announcing in the press that the bodies so used were those of criminals who had been legally executed and "now and then one from the Potter's Field.'' ~'hree years later, in 1765, William Shippen began the first systematic lectures on obstetrics which were given in this country. These were illustrated by the ''anatomical plates and casts of the gravid uterus at the hospital." The Pennsylvani(t Gazette. of .Jan. 1, 1765, carried the following advertisement: ''Dr. Shippen, Jr., having been lately called to the assistance of a number of women in the country in difficult labors, mo8t of which were made so by the unskilful old women about them; the poor women having suffered extremely, and their innocent little ones being entirely destroyed, whose lives might have been easily saved by proper management: and being informed of several desperate cases in the different neighborhoods which had proved fatal to the mothers as welll as to their infants, and were attended with the most painful circumstances, too dismal to be related! He thought it his duty immediately to begin his intended courses in Midwifery, and has prepared a proper apparatus for that purpose, in order to instruct those women who have virtue enough to own their ignorance and apply for instruction, as well as those young gentlemen now engaged in the study of that useful and necessary branch of surgery, who are taking pains to qualify themselves in practice in different parts of the country with safety and advantage to their fellow citizens.'' Some idea of the conditions prevailing in the obstetrics of that day may be gained from a statement by Shryock who observes, "Maternity cases were left, in English speaking lands, almost entirely to midwives. Despite the general coarseness of the age, the attellldance of men upon maternity cases was held to be most indelicate. The apparent paradox may possibly be explained in terms of matrimonial jealousy and suspicion. Whatever the explanation, the fact remains. And since midwives lacked any scientific training, obstetrics proceeded on the level of folk practice with consequences which may easily be imagined.'' Shippen established what was practically a lying-in hospital in providing "convenient lodgings" for a few poor women, "under the care of a sober, honest matron, well acquainted with lying-in women.'' He also informs his prospective pupils that he will "be able to present each of you with one natural labor at least, and have provided a machine, by which I can demonstrate all kinds of laborious and preternatural labor, and so give every necessary direction to enable you to manage all t:ases with the greatest safety to mother and child.'' On May 3, 1765, the Trustees of the College of Philadelphia having considered John Morgan's project to establish a medical school gave the plan approval and elected him Professor of the Theory and Practice

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of Medicine. This was the beginning of the medical department of the University of Pennsylvania. In S0ptcmhm· of: the same year William Shippen was elec·ted Professor of Anatomy and Surgery. Anatomical lectures were given by him regularly until the fourteenth course whirh was in the winter of 1775 when t hr 'Vur of the Hevolution caused their suspension. Wistar says regarding Shippen's manner of teaching, ''He went through the substance of each prec·cding leetnrc by interrogation, instead of recapitulation, thm; :fixinl.!: the attention of the students--and his manner was so happy, that this grave proress proceeded like n piece of amusement.'' The puhli(' intrre:>t in Shippen',; lectureR and demonstrationR is shown b,,- a notation in ,John Adams' diary which reads, "Dr. Shippen rarried n~ into his f'hmnber where he showed a series of anatomic•al paintingi'l of l'Xquisite art. Ht're was a great ntrit•iy of views of the hnman hody: whole nne! in pm't. The Dortor entel'tained us with a dear, coneisf'., «omprdwnsive ledut·t· upon all parts of the human frame. The entPrtainmPn1 dJarmed nw. '' In 1779 the lcgislatnre repealed the ehar·tt·r· of the College of Ph iladelphia at the time of the ('reation of the l-ni vPrHity of Pmnsylvania and Hhippen became a professor in the new school. In 1783 the charter of the College being restored, for a time he CH'rupied chairs in hoth schools, and when a ronsolidation took plaet' in 1791 nuder the title of the former institution he oreupied tlw ehair ol' anatomy, surgery nnd midwifi'ry with Caspar Wistar as ndjunrt proh'ssoJ'. William Shippen's first militan' position, aeeonling to Packard, was that of medical direetor of the J1'lying· Camp in the ,Jerseys and as sueh was under the authorit,\- of John l\Torgan as director-general. A short time after, when Morgan was dismissed as director-general, Shippen was advanced to director of hospitab on the wrst side of the Hudson River, those on the cast side remaining mH10r the authority of Morgan. Subsrqnently Shippen with the aid of ;John Coehran, w·ho had seen service as surgeon's mate in the Frend1 and Indian 'vars, outlined a plan of reorganization whirh was adopted hy Congress early in the spring of 1777. On April 1I of that year aceording to Brown, quoted by Graves, ''To the position of Dircetor Oenrral, Dr. Philip Turner of Connecticut was at first nominated and elected, hut before adjournment a reconsideration was moved, and it waR urged with great propriety that the author of the plan had claims, not only of grt>at distinction in his profession, hut of previous service, which were superior to those of others. Accordingly a new election being held, Dr. William Shippen received the unanimous vote of all the thirteen states." It is not within the present seope to tell of Shippen's military career. vYe enn hut mention his famous courtmartial, instigated largely hy l1,ush and .M.organ, which resulted in his aquittal on all counts and following whir·h the eommander-in-ehief publicly thanked him for his exeellent seniec. To those interested in this dramatic and historic episod<• rnfm·em•e is dirrch•d to Oihson 's exeellent volume on the medi<•al ba('kground of the Revolution. Shippen attributed the animosity of hoth Rush and Morgan to the belief that he had forced them out of military preferment. It is interesting to note with regard to the former that time probably healed these ugly wounds for in Rush's diar~' of July 11, 1806, it is reeorded, "Shippen died today! I attended him in his last illness.'' Shippen remained as Director General until ,Jannary, 1781, at which time he resigned and resumed his teaching and praetiet'. l n obstetrics he succeeded in rombating the prejudice against men in this hraneh to such an extent that he secured a large clientl?le.

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In 1798 a great tragedy of his life occurred in the death of his only son. Wistar says this ''cut the sinews of his exertions, and left him gradually to wither-the amiable victim of paternal affection." He lectured but occasionally after this and his practice declined. However, toward the latter part of his life his interest in medicine seemed to return, and we find an account of him ag-ain giving his introductory lecture in new buildings now to a elass of nearly four hundred. In 1808, his debility returned and he removed to Germantown where he passed away the eleventh day of ,July. 'rhe men with whom we assoeiate the word great are usually those whose contributions are of a twofold nature, namely, the things that they did and the lives that they influenced. William Shippen established the teaching of clinical obstetrics in this country and his influence on hundreds of his pupils extended throughout the then settled America. When we consider the eonditions which faced him in the doing of this task, we must believe that, as it was said of William Smellie: "Man midwifery was the idol of his heart." In eonsidering Shippen's early establishment of a teaching hospital it is interesting to note that it was not until after his return from abroad that the first institution especially esablished for instruction in obstetrics was founded in London (1765). William Shippen, eminent in the establishment of anatomical teaching and the development of military medirine, remains the Great Pioneer in American Obstetrirs. RE!<'ERENCEB

Flexner, J. T.: Doctors on Horseback, New York, 1937, The Viking Pr<>SS. Gib· son, J. E.: Dr. Bodo Otto and the Medical Background of the American Revolution, Springfield, Ill., and Baltimore, 19:i'i. Goodman, N. a.: BE"njamin Rush, Physician and Citizen, Philadelphia, 19:14. GTa·Pes, C. B.: Ann. Med. Hist. 10: 1, 1938. Kelly, H. A., anrl Burrage, W. L.: American Medieal Biography, Baltimore, 1925. Middleton, W. 8.: Ann. Mec1. Hist. 4: 440, 1932. Packard, F. R.: Ann. Med. Hist. 4: 219, 1932. Paul, .J. R.: .T. TPc.•h. Methods & Bull. Intern. Assn. Med. Museums 12: 19, 1929. Pilcher, ,J, R.: .T. Assn. Mil. Rurg. U. S., Carlisle, Pa. 14: 60, ;1~904. Short account of the late Dr. Shipp<>n of Philadelphia, father of Professor Shippen of the Univ. of Pa., written by one of the granddaughters of the deceased. Med. Re:pos., N. Y. 5: ~155, 1802. Shiz)pen, Nancy: Nancy Rhippen-Her Journal Book Compiled and Edited by Ethel Armes, Philadelphia, 1935. Shryock, R. H.: The Development of Modern Medicine, Philadelphia, 1936. 8ter:ne, Lanrence: Letters of, in "~'he Works of Laurence Sterne," Philadelphia, 185i. Thacher, .T.: A military journal during the American Revolutionary war, from 1775 to 1 78il., Boston, 1827. Thacher, J.: American Medical Biography, Ro~ton, 1828. Toner, .J. M.: The Medical Men of the Revolution, Philadelphia, 1871i. Williams, J. W.: A Sketch of the History of Obstetrics in the TJ. 8. up to lSi H), Baltimore, Md. Wistwr, C.: Phila. ,r. Med. & Phys. Sc. 5: 173, 1112:2.

Vaccaro, Hugo, et al.: Clinical and Bacteriological Considerations Upon Ovular Infections, Bal. Soc. chilena de obst. y ginec. 1: 237, 1936. After exhaustive studies the authors came to the conclusion that the amniotic fluid constitutes a very good medium for the growth of micro-organisms. Because of its encapsulation, 91 per cent of 22 specimens of amniotic fluid were found to be sterile. The Bacillus perfringens was discovered in 2 of the 22 patients, although they had intact membranes. MARIO

A.

CAST AUO.